Emerging biotechnologies: full report - Nuffield Council on Bioethics

E m e r g i n g b i o t e c h n o l o g i e s
Box 1.1: Attitudes to biotechnology
Attitudes towards <strong>biotechnologies</strong> vary considerably between individuals and over time. Different attitudes may persist in
relation to both prospective <strong>biotechnologies</strong>, and to technologies that are already implemented and well diffused, where
evidence relating to them is available. Indeed, attitudes may continue to vary as new evidence and understandings
emerge. The examples given below are therefore provisional, and simply suggest where the bulk of opinions appear to
converge at the present time.
High impact,
Positive net benefit
Biotechnologies about which opinion converges in
this quadrant are those considered most socially
desirable; these may include important ‘public
goods’, for example vaccination. a
Low impact,
Positive net benefit
Biotechnologies about which opinion converges
in this quadrant may be socially desirable but are
more likely to be privately valued (some
medicines, for example b ).
a
b
c
d
High impact,
Negative net benefit
Where opinion converges in this quadrant
<strong>biotechnologies</strong> are likely to involve significant
public harms or risks. These may not be apparent
at an early stage so technologies may be widely
implemented before they are recognised. Examples
outside biotechnology include chlorofluorocarbons
(CFCs) and asbestos. c
Low impact,
Negative net benefit
Comparatively poorer performance than
alternative; they may tolerated owing to a greater
value being placed on the exercise of individual
freedom (for example, technologies on the
borderline of ‘health care’ d ).
The impact and positive benefit of vaccines is well documented. 5 However, although vaccination is generally considered
to have a positive net benefit, this is contested by some groups (especially in relation to compulsory vaccination). 6
Medicines for certain cancers rejected on the basis of cost-effectiveness (such as by the National Institute for Health
and Clinical Excellence (NICE) in the UK) might also fall into this category when they are deemed to have too little
benefit in comparison to their cost-per-patient – i.e. if life is extended by a marginal amount. 7
Both CFCs and asbestos, about which the balance of opinion has now moved fairly decisively into this quadrant, were
very effective for their intended use but turned out to have extremely harmful and widespread collateral consequences.
It has been suggested that some applications of genetic screening (pre-implantation, 8 preconception, 9 personal genetic
profiling 10 ) may, under some perspectives have negative benefit (raising anxieties unnecessarily, involving medical
procedures with no clear benefit, giving false confidence, causing unnecessary pressure on public health services,
etc.). However, there is usually sufficient ambiguity about the harms that the infringement of personal and commercial
freedom that would be involved in banning those technologies argues against prohibiting them. This tolerance may be
important – it is worth recalling that the balance of views about many ‘disruptive’ technologies may be initially fall into
this quadrant.
The biotechnology balance sheet
1.7 Examples of genuinely harmful technological impacts from the past should be hard to find as
markets, governance and regulation should weed them out before significant harmful effects
accumulate. However, it may take some time before undesirable effects are recognised and
5
6
7
8
9
10
“The impact of vaccination on the health of the world’s people’s is hard to exaggerate. With the exception of safe water, no
other modality, not even antibiotics, has had such a major effect on mortality reduction or population growth.” Plotkin SL and
Plotkin SA (2004) A short history of vaccination, in Vaccines, Plotkin SA Orenstein WA and Offit PA (Editor) (China:
Saunders Elsevier), p1. See also: Payette P and Davis H (2001) History of vaccines and positioning of current trends Current
Drug Targets - Infectious Disorders 1: 241-7.
For a discussion of attitudes to vaccines and vaccination programmes, see: Larson HJ, Cooper LZ, Eskola J, Katz SL and
Ratzan S (2011) Addressing the vaccine confidence gap The Lancet 38: 526-35.
See, for example, the situation in the UK with regard to the drug everolimus: NICE (2012) Everolimus for the second-line
treatment of advanced renal cell carcinoma, available at: http://publications.nice.org.uk/everolimus-for-the-second-linetreatment-of-advanced-renal-cell-carcinoma-ta219,
and BBC Online (2011) NICE rejects kidney cancer drug everolimus,
available at: http://www.bbc.co.uk/news/health-13115961.
Brown R and Harper J (2012) The clinical benefit and safety of current and future assisted reproductive technology
Reproductive Biomedicine Online 25: 108-17.
Human Genetics Commission (2011) Increasing options, informing choice: a <strong>report</strong> on preconception genetic testing and
screening, available at:
http://www.hgc.gov.uk/UploadDocs/DocPub/Document/Increasing%20options,%20informing%20choice%20-%20final.pdf.
The issue of genetic profiling has also been subject to considerable and recent debate. See, for example, <strong>Nuffield</strong> <strong>Council</strong> on
Bioethics (2010) Medical profiling and online medicine: the ethics of 'personalised healthcare' in a consumer age, available
at: http://www.nuffieldbioethics.org/personalised-healthcare-0; Human Genetics Commission (2003) Genes direct, available
at: http://www.hgc.gov.uk/UploadDocs/DocPub/Document/genesdirect_<strong>full</strong>.pdf and Human Genetics Commission (2007)
More genes direct, available at: http://www.hgc.gov.uk/UploadDocs/DocPub/Document/More%20Genes%20Direct%20-
%20final.pdf.
10